Richard Plunkett, an emergency physician in Yakima, Wash., complains about the ever-increasing rules for getting paid by Medicare and Medicaid.

"The federal government's documentation requirements to get paid have escalated every year, forever," says Plunkett. "We get feedback all the time, saying, 'You delivered a level four service but you missed a bullet here and there, so we could only code it as a level three,' because the government's position is, if you code it higher than it should be, it's fraud."

Reynolds laments the need to store all the medical records that the practice has built up over the years. "Office space can be very expensive," she says. "And when you obtain this very expensive space just to store records, it doesn't feel right, but you have to have the records here so you can access them when you need them."

Reynolds is happy with her group's practice management system, GE Medical Systems' Centricity Physician Office — Practice Management (formerly Millbrook Practice Manager), but says she'd love to have an EMR if only to free the practice of the mounds of paper it deals with.

But her worst fear, she says, is buying the wrong system: "It could be that we're a little scared. But I tell you, whenever I read a journal, and I read an article that says, 'We now have the right EMR,' I think that's awful — that scares me to death."

One solution might be to "build your own" EMR — to make use of your existing information technology infrastructure, perhaps adding a few relatively inexpensive items, to digitize your practice, suggests Woodcock. Here's how:

• Create a shared database by organizing your transcribed office notes (in electronic form) by patient identifiers. Through a database program, you can put the notes on a local area network and access them by your designated identifier. That makes each note accessible to every physician on the network — a great solution for practices that share patients.
• Get rid of paper by scanning every scrap that comes into your office, from lab results to operative notes. Add the scanned images to your database. You can even scan patients' insurance cards and EOBs to improve efficiency in the billing office.
• Use personal digital assistants to capture charges and download the charge information into your computer system.
• Use e-mail and instant messaging to distribute telephone and other messages internally.
• Post pertinent information to which you or your staff needs quick access on a secure Web site. You may be able to set up a very simple site for a small fee, or for free, through your Internet Service Provider.

A do-it-yourself system like this one surely won't have all the capability of true EMR. But it may be a good, inexpensive, interim step for practices interested in, but scared of, taking the EMR plunge.

Worth the effort

Modern physicians are victims of their own success — and of society's. As medicine has advanced, patients have gotten the idea that nearly anything can be cured and that doctors should be perfect every time. Moreover, as societies have sought to protect the poor and vulnerable with government benefits programs, some people have concluded that not only should their healthcare be flawless, it ought to be free, too.

That leaves physicians in a difficult position. But not an impossible one. With diligence and imagination, you can make your practice run more smoothly, improve the quality of your life, boost revenue, lower overhead, and even keep your patients happy. It isn't easy. But it's worth the effort.

Bob Keaveney, editor for Physicians Practice, last wrote about practicing "bare" in the May issue. He can be reached at
bkeaveney@physicianspractice.com.

This article originally appeared in the June 2004 issue of Physicians Practice.